Health and attendance in the NHS

If the nine million days a year lost by the NHS through staff absences could be reduced by giving them priority for OH treatment, the savings would benefit everyone.

In May 2013, the Department of Health (DH) published new guidance on the Health workforce information review. This rather dry set of documents sets out the DH’s and Health Education England’s vision of planning for future workforce needs. Under the Health and Social Care Act 2012, providers of NHS-funded care will play a more prominent role in the arrangements to educate, train and develop the workforce and will need to be more actively involved in planning their future workforce needs and in sharing the results of their plans with others. The information review states a requirement for education and training to be underpinned by accurate, comprehensive, complete and timely workforce information to ensure the workforce truly reflects the needs of local service users.

Nowhere in the documents is there a mention of OH. You might wonder why there would be, and you might have a point. But think about this: any workforce planning for an organisation of 1.35 million employees (1.1 million full-time equivalents (FTEs)) needs to take account of how many of those people are in work on a daily basis – or not, as the case may be. Crunching the numbers identifies some staggering statistics.

Average working days

Taking the 1.1 million FTE figure and multiplying it by 228, which is a commonly used number of days worked in a year when weekends – or days off – and holidays are taken out, puts the total number of annual working days in the NHS at 263 million. Public-sector absence was stated at 7.9 days per employee per year by the Chartered Institute of Personnel and Development and Simply Health Annual absence management survey report 2012, which puts the total number of lost days annually at more than nine million.

This is enough days to run the whole of the NHS in Bristol with two large teaching trusts, all of the GPs and other services for two years with capacity to spare.

Trying to put a cost on all this is not easy, as there is plenty of conflicting information about the NHS average salary, but totaljobs.com puts it at £42,500. I am sure many nurses and other lower paid but vital staff will baulk at this figure, but there are plenty of consultants and senior staff on much more than £100,000, so it might not be far off – 7.9 days per year is 3.46%, and 3.46% of £42,500 is £1,470. Multiply that by 1.1 million and the total is £1.617 billion.

Give or take a bit – and I accept that the calculations might appear a bit crude – this is the amount paid to NHS staff not to attend work because of sickness in any given year. Remember, this is the cost of non-attendance, not the true cost of absence – that will be much higher.

I am not trying to bash the NHS. It has plenty of problems without me having a go. Also, you could make the above calculations and come up with some pretty scary figures for any business – big or small. The level of absence and staff ill health in the NHS is not dramatically different to that of any other large public-sector organisation. It is just that the NHS is so big that the numbers look so gobsmacking. But is that not the point? A small change either way potentially costs or saves so much – and not just in monetary terms.

The NHS, as with many public-sector organisations, is caught in a political trap. Any money not spent on patients is exhaustively scrutinised. Any sizeable amount spent on staff sends shivers down a trust chief executive’s back, lest the local or national press prime their keyboards for some very uncomfortable headlines. You can see the “Daily Mail” now – “Hospital nurses get free fast-tracked physio while disabled war hero waits eight weeks”.

Reverse turn

But is it not time the trap was sprung the other way? Good care comes from staff who are both healthy and well motivated, so why should the spotlight not be on the trust, clinical commissioning and provider managers to ensure excellent OH care and staff attendance? Boosting that attendance with all reasonable means and benefits should be the number-one priority. If someone is off sick, get them assessed today. If someone needs physiotherapy for a back problem, give it to them now. If they need counselling, provide it as soon as you can get an appointment. If you treat your staff well, they will treat the patients well and the disabled hero will get his physiotherapy a lot quicker.

All these measures cost money, but poor care and staff absence cost far more. If the NHS needs a detailed workforce plan for the next 10 years, it should plan for the staff to be there – fit, healthy and raring to go.